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Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Nephrotic syndrome is of different causes based on patient age. The most common primary causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Minimal change disease causes a fast onset of edema and heavy proteinuria, and usually affects children, with renal function remaining normal in most cases. Secondary causes only make up fewer than 10% of childhood cases. However, secondary causes make up more than 50% of adult cases, and include diabetic nephropathy and preeclampsia. Amyloidosis causes 4% of all cases. HIV-associated nephropathy occurs in patients with AIDS, and is a form of focal segmental glomerulosclerosis.
Drug-Resistant Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Keertan Dheda, Aliasgar Esmail, Anzaan Dippenaar, Robin Warren, Jennifer Furin, Christoph Lange
Factors contributing to the development of renal dysfunction, such as diarrhea and dehydration, should be addressed. Diuretic use and concomitant administration of other nephrotoxins should be rationalized.213 The underlying cause of renal dysfunction may be due to a concomitant medical condition (e.g., hypertension, diabetes) or due to toxicity attributable to ARVs (e.g., tenofovir) and/or anti-tuberculous therapy (e.g., aminoglycoside). The risks of iatrogenic nephrotoxicity may be greater due to the background prevalence of HIV-associated nephropathy (HIVAN) in Africa.213,214 The use of tenofovir and/or aminoglycoside should be avoided in such patients, especially if the patients have advanced HIV215,216 with proteinuria.215,217
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Many opportunistic diseases can affect the kidney (e.g. cryptococcosis, CMV infection of the tubules, pyaemic bacterial infection, tuberculosis, lymphoma), but one specific entity is important – HIV-associated nephropathy (HIVAN). Clinically, this condition presents with renal failure and nephrotic syndrome. Pathologically, it is characterized by focal segmental glomerulosclerosis (FSGS) with a typical ‘collapsing’ appearance (collapsing glomerulopathy, see Chapter 14) and interstitial inflammation with tubular atrophy and dilatation. It appears to be caused directly by HIV, and is significant because it is an ethnically restricted opportunistic disease in HIV/AIDS: it occurs only in people of African descent.
Evaluating emtricitabine + rilpivirine + tenofovir alafenamide in combination for the treatment of HIV-infection
Published in Expert Opinion on Pharmacotherapy, 2020
Ying Mu, Michelle Pham, Anthony T. Podany, Theodore J. Cory
Both FTC and TAF are largely excreted via the kidney. Due to HIV-associated nephropathy, people living with HIV are more prone to kidney disease which can be exacerbated by ART [48,49]. Tenofovir has been previously reported to lead to reduced renal function, such as acute renal failure and Fanconi syndrome, an excess amount of electrolytes and other substances in the urine caused by dysfunction of proximal renal tubules of the kidney, and an increased risk of developing renal-rated adverse reactions in patients with impaired renal function or patients taking other nephrotoxic agents [29]. However, TAF-containing regimens have been shown to cause less impact on renal function compared to TDF-containing regimens in the 2 essential phase III switch studies GS-US-366-1216 and GS-US-366-116. Renal function was improved after switching to TAF/FTC/RPV from a TDF-containing regimen: median creatinine clearance was increased at week 4 and week 48 by switching to TAF/FTC/RPV treatment in both studies. At week 48, quantitative proteinuria (urine protein to creatinine ratio and urine albumin to creatinine ratio) and tubular proteinuria (Urine β-2 microglobulin to creatinine ratio and urine retinol-binding protein to creatinine ratio) were also improved with the switch to TAF/FTC/RPV in both studies [11,46]. At week 96, kidney function was similarly improved as week 48 (creatinine clearance, quantitative proteinuria, and tubular proteinuria) in the study GS-US-366-1160. However, in the study GS-US-366-1216, increases, rather than decreases were observed at week 96 in the UACR (urine protein to creatinine ratio) and RBP (urine retinol-binding protein) to creatinine ratio [47].
Prevalence of kidney injury in patients taking tenofovir based antiretroviral therapy at a primary health care clinic, in East Rand,Gauteng Province
Published in Hospital Practice, 2021
P Makamu, S Bezuidenhout, M Matlala
The introduction of highly active antiretroviral therapy (HAART) in South Africa (SA) has brought a significant decline in HIV-related mortality and morbidity [1]. Prior to the antiretroviral therapy (ART) era, HIV-associated nephropathy (HIVAN), HIV-associated thrombotic microangiopathy, and immune-mediated glomerulonephritis had been frequent causes of end-stage renal disease which necessitated dialysis [2]. Antiretroviral therapy has however been associated with both improvement and preservation of renal function and an improved chance of survival among HIV-infected patients [3]. HIV-associated end-stage renal disease (ESRD) also became less prevalent, suggesting the role of antiretroviral therapy in reducing the risk of HIVAN [3].
A case of HIV associated cryptococcal nephritis: Ultrastructural findings and literature review
Published in Ultrastructural Pathology, 2018
Ashley Flowers, Xin Gu, Guillermo A Herrera, Sandy Gibson, Judy King
Although HIV-associated nephropathy (HIVAN) is the best known manifestation of HIV-associated kidney disease, a variety of renal injury originating from several mechanisms is now known. These mechanisms can involve direct infection of kidney cells, immune response to viral antigens and opportunistic infections, effects secondary to antiretroviral therapy and therapy for other infections, as well as other chronic disease that cause renal injury.12Therefore, in addition to the most prevalent HIVAN, less common entities should be included in the differential diagnosis. In any patient with systemic cryptococcosis, renal injury secondary to direct infection or immune-modulated glomerular injury should be considered.